Historical risks of tuberculin skin test conversion among non-physician staff at a large urban hospital

BACKGROUND

Nosocomial transmission of Mycobacterium tuberculosis among workers at a 1000-bed inner-city hospital led to an extensive evaluation of this risk among workers with potential exposure to TB patients or laboratory specimens.

METHODS

Retrospective cohort study to determine the incidence and risk of tuberculin skin test (TST) conversions among workers employed 1/1/90 to 9/30/92.

RESULTS

Personal, community, and occupational risk factors were evaluated in 2,362 workers with potential M. tuberculosis exposure and 886 workers with no known exposure. The 33-month cumulative rate of TST conversion was 5.8% for potentially exposed workers and 2.0% for controls (RR 3.6; 95% CI; 2.2-5.8). Among workers with potential M. tuberculosis exposure, statistically significantly elevated risks were found for nurses, laboratory technicians, pharmacy workers, phlebotomists, housekeepers, clerks, emergency room workers, and emergency responders.

CONCLUSIONS

Workers with patient contact and those employed in certain occupational groups were at increased risk for occupational M. tuberculosis infection.

Consumption, knowledge and attitudes of high school pupils towards alcohol and alcoholism: the Israeli experience

Five hundred nine high school pupils from Holon (a city in the center of Israel) were surveyed about their consumption, knowledge and attitudes towards alcohol use and alcohol dependence. Two hundred fifty-nine pupils attended a vocational high school and 253 attended an academic high school. Forty percent of the pupils attending the academic school reported that they had drank beer between one to nine times during the last 2 months. In comparison with 72% of the vocational pupils, 42% of the academic pupils and 47% of the vocational pupils drank other alcoholic beverages (such as hard liquor, cognac, whisky or vodka) between one to nine times during the last 2 months. Boys drank alcohol more frequently than girls did. An earlier mean age of beer consumption was found among pupils in the vocational schools-12.8 years; as opposed to pupils in the academic school-13.4 years. Knowledge of most pupils concerning alcoholic beverages and its potential harmful effects was lacking and pupils in the academic school showed a higher level of knowledge in comparison with the vocational pupils. Pupils in the vocational school had more liberal attitudes concerning recurrent consumption of alcoholic beverages than pupils in the academic school. Among the three leading reasons for drinking in the two schools were helping foster a sense of belonging, wish to feel like an adult and desire to forget daily anxieties and conflicts. Pupils in vocational schools are a target population with a higher risk for consuming alcoholic beverages. Discussion groups should be held in school and include personal stories of recovering alcoholics.

Blood pressure, left ventricular mass, and lead exposure in battery manufacturing workers

BACKGROUND

Although debate about the relationship between lead and blood pressure has focused on low environmental lead levels, industrial exposure remains a concern.

METHODS

We measured blood pressure and left ventricular mass (LVM) in 108 battery manufacturing workers, and calculated cumulative and historic average measures of blood lead.

RESULTS

Diastolic pressure increased with increasing lead levels, with a significant (P = 0.04) 5 mmHg difference in mean pressure between the highest and lowest cumulative exposure levels. Diastolic pressure increased with the log of cumulative lead (P = 0.06). Both hypertension (defined as currently medicated or systolic > 160 mmHg or diastolic > 95 mmHg) and LVM increased nonsignificantly with increasing lead exposure (P-values > or = 0.17 for hypertension and > or = 0.20 for LVM).

CONCLUSIONS

We found a small effect of blood lead on diastolic blood pressure, particularly for a cumulative measure of exposure, but no convincing evidence of associations between lead and other blood-pressure-related outcomes. Published 2001 Wiley-Liss, Inc.

[Nutritional characteristics of cereal and peanut bars]

Snack with good nutritional value could play an important role in the physical and mental development of children and teenagers since they show a great preference for them. The tendency is increasing their nutritional value by supplying proteins, carbohydrates, fiber, vitamins and minerals in a balanced form. The purpose of this research was to evaluate the chemical, sensorial and nutritional quality of cereal and peanut bars. Three types of bars using different ratios of oat, wheat germ, peanut, toasted and expanded amaranthus and wheat extrudate were prepared. Bars proximate composition was determined according the AOAC methods, and their acceptability according Hedonic Scale. In the biological assays, rats fed with 10% protein diets, were used to obtain the Protein Efficiency Ratio (PER) Net Protein Ratio (NPR) and Apparent Digestibility (AD). Corrected PER, relative PER, relative AD, PER and NPR values did not showed difference between bars CM1 and CM2 (PER: 2.59-2.57; NPR: 3.99-3.95 respectively); CM3 bar showed a lower quality. There were not differences among bars in relation to AD. CM1 and CM2 bars had a better biological quality of the protein being CM3 bar of lower quality. From a chemical and sensorial point of view CM1 bar shows the highest protein content (14.23%) and acceptability (6.8) and CM2 bar shows a high raw fiber content (2.27%).

[Storage and use of antioxidants in cereal and peanut bars]

The use of fatty materials in cereal bars gives to them a good energetic value; however they are exposed to oxidative rancidity which can affect their acceptability and nutritional value. So, the purpose of this research was to determine the stability in storage and the effect of antioxidants on three tipes of cereal bars with peanuts. Cereal bars with 18% of peanuts were prepared, with and without antioxidants (BHA + BHT; 100 ppm). Bars were packed in polyprolpilene-aluminium-polythilene bags, and were stored at room temperature (18-20 degrees C) for 90 days. Each 30 days, analysis of water activity (Aw); moisture content, peroxides index, sensory quality (flavor, aroma and appearance) and acceptability, were carried out. Moisture content was similar in all bars (7.6-9.6%) and Aw was higher in the bar which contained expanded amaranthus and antioxidant. At the 60th day of storage, the peroxide values were lower in the bars with antioxidants; only the bar which included expanded amaranthus showed significant differences (16.4 meq/kg in the bar with antioxidant and 25.7 meq/kg for the control bar). The sensory parameters were kept within normal status without differences between the bars with antioxidants and the control ones, along all the storage period. Shelf life of bars CM1 and CM2 was at least of 60 days when they are kept at 18-20 degrees C.

Coplanar PCBs and the relative contribution of coplanar PCBs, PCDDs, and PCDFs to the total 2,3,7,8-TCDD toxicity equivalents in human serum

Coplanar PCBs in human serum were measured by high-resolution gas chromatography/isotope-dilution high-resolution mess spectrometry in 46 pulp and paper mill workers and 16 community residents with no specific known source of PCB exposure. The relative contribution of coplanar PCBs, PCDDs, and PCDFs to the total 2,3,7,8-TCDD toxicity equivalents (TEQs) were compared using the toxic equivalency factors proposed by Safe [1] and the factors recently proposed by WHO [2]. The mean concentrations of PCB-126 and PCB-169 were higher in paper mill workers than in community residents. However, these differences were not statistically significant. Serum PCB-126, but not PCB-169, was correlated with body mass index (Spearman's r = 0.40, p = 0.002). Serum PCB-169, but not PCB-126, was correlated with age (Spearman's r = 0.54, p = 0.0001). Multiple linear regression analysis for log-transformed combined PCBs showed that age (p = 0.008), body mass index (p = 0.031), and eating locally caught fish (p = 0.019) were statistically significant predictors. The majority of the total TEQ in serum is due to PCDDs (63%), whereas PCDFs account for 21% and coplanar PCBs account for 15% when calculated using the TEFs proposed by Safe. The percent contributions from PCDDs, PCDFs, and coplanar PCBs were 66%, 24%, and 10% respectively when calculated based on the TEFs proposed by WHO. Age, body mass index, and consumption of locally caught fish are significant predictors for coplanar PCB levels in human serum. Serum PCDDs were the major contributors to the total 2,3,7,8-TCDD equivalent toxicity in this study.

Serum levels of polychlorinated dibenzo-p-dioxins and dibenzofurans in pulp and paper mill workers

Serum levels of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) among 46 long-term workers at a pulp and paper mill were compared to the levels in 16 community residents who never worked at the mill. Overall, there were no appreciable differences among the three exposure groups (community resident, low-exposure-potential worker, high-exposure-potential worker) for specific PCDDs or PCDFs. Neither exposure group nor duration in high-exposure-potential-jobs was related to total toxic equivalents (I-TEQ). Serum levels of PCDDs and PCDFs in this study generally were within the range previously reported for persons with no known occupational exposure.

Monitoring of exposure to benomyl in nursery workers

We compared urinary levels of the metabolite methyl-5-hydroxy-2-benzimidazole carbamate (5-HBC) among nursery workers exposed to the fungicide benomyl (specifically Benlate 50 DF [DuPont, Wilmington, DE]) and workers not exposed to benomyl. Environmental exposures were quantitated from gloves, body patches, and air samples collected with area and personal monitors. The median concentration of 5-HBC in the urine of benomyl-exposed workers was 23.8 mumol of 5-HBC per mole of creatinine. No 5-HBC was detected in the reference group. Industrial hygiene results and biological monitoring findings indicate that use of Benlate 50 DF in the ornamental industry can lead to absorption of the active ingredient, benomyl. Weighing, mixing, and application activities involved the highest exposures. Dermal contact appeared to be the primary route of exposure.

Waldenstrom's macroglobulinemia: search for occupational exposure

Two cases of Waldenstrom's macroglobulinemia (WM) that occurred in employees from one university academic department were investigated using approaches for both cluster and single case investigation. Common personal characteristics and potential past hazardous exposures were evaluated. The patients shared a young age at diagnosis, worked in the same building, and had similar duration of time between first entering the building and diagnosis of WM. No evidence was found to support the original hypothesis that exposure to radioactive material could be related to the occurrence of WM. Although this investigation did not identify a common causal agent among two cases of a rare disease, investigations of disease clusters may be useful for developing etiologic hypotheses even when a full-scale epidemiologic study is not undertaken. Detailed descriptions of case characteristics can help generate ideas for further research.

Knowledge of medical history information among proxy respondents for deceased study subjects

Proxy respondents were interviewed for 96 decedents in an occupational cohort. A second respondent was interviewed for 59 decedents. Medical records were reviewed to validate questionnaire information. The percentage of respondents who answered "don't know" (non-response) to questions about medical condition ranged from 5% (cancer and heart disease) to 17% (ulcers). Non-response rates were lowest among spouses, intermediate among children, parents, and siblings, and highest among other relatives and friends. Among 41-55 pairs, depending on the condition, agreement between paired respondents was excellent (kappa > 0.75) for ulcers, cancer, diabetes, and lung disease. A higher percentage of medical records was obtained for decedents with spouse respondents and for decedents with more recent dates of death. Sixty percent or more of the medical records were obtained for patients with cancer (n = 30), heart disease (n = 26), stroke (n = 9), and liver disease (n = 10). The positive predictive value of the proxy respondent information for these conditions was 93, 81, 78, and 60%, respectively.

Surveillance of occupational lead exposure in New Jersey: 1986 to 1989

Between January 1986 and June 1989, 1916 New Jersey workers were identified through a surveillance system for occupational lead exposure. The average annual proportion of workers with a blood lead level above 2.42 mumol/L was 12%. Industries with the highest proportion of workers with blood lead levels above 2.42 mumol/L were special trade construction (35%) and industries dealing with scrap and waste materials (27%).

Asbestosis in New Jersey

A survey was conducted of 1,079 individuals reported by New Jersey hospitals to the New Jersey State Department of Health. Forty-eight percent of the respondents indicated that they had not received financial compensation for their work-related disease; 415 different sources of exposure to asbestos were identified.

Acute occupational respiratory diseases in hospital discharge data

We investigated the feasibility of using hospital discharge diagnoses of ICD codes 506, 507, and 508, respiratory diseases from external sources, to identify occupational sentinel health events [SHE(O)]. Two hundred sixty-nine records were reviewed and 66 (25%) were incidents where the work-relatedness of the respiratory diseases was documented in the medical records. Twenty-six percent of the 269 records contained no exposure information. Sixty-four of the 66 occupational cases were from ICD codes 506.0-506.9, with the largest number classified as ICD codes 506.0 (bronchitis and pneumonitis due to fumes and vapors) and 506.3 (other acute and subacute respiratory conditions due to fumes and vapors). We conclude that surveillance of ICD codes in the 506 series, where 39% of the cases were secondary to occupational exposures, is a valuable component of a surveillance system for preventable occupational lung disease.

A longitudinal study of pulmonary function in fire fighters

Pulmonary function changes among fire fighters were evaluated by re-examining 632 Baltimore city fire fighters six to ten years after a baseline examination. Spirometry was used to determine forced expiratory volume in 1 second (FEV1). Information about exposures was obtained by questionnaire and by combining data from fire department records regarding the number of fires fought by fire fighting units with individual work histories. Men who never wore a mask while extinguishing fires experienced a 1.7 times greater rate of FEV1 decline than mask wearers. Men with ammonia exposure experienced a rate of decline 1.7 times greater than non-exposed men. Neither length of time spent in exposed jobs nor number of responses were associated with the rate of decline. Active fire fighters experienced a rate of decline 2.5 times greater than those who had retired or resigned. Some effects differed between men who were able to perform repeatable pulmonary function tests and those who were not.

Limitations of hospital discharge diagnoses for surveillance of extrinsic allergic alveolitis

Hospital discharge diagnoses were used to identify all inpatient cases of extrinsic allergic alveolitis (EAA) from 1979 to 1982 in New Jersey. Of 170 reported cases, the hospital records of 48 were available for review. Based on published criteria for the diagnosis of EAA, only three cases (6%) could be classified as probable EAA, while 10 (21%) were possible cases, and 34 (73%) were not EAA. Limitations were apparent in the accuracy of discharge coding and also in the accuracy of the physician's diagnosis. These findings should promote caution among investigators using unvalidated reports based on ICD-9 hospital coding of EAA. Implications for reporting of other occupational lung diseases are discussed.